Issue

Whether a claimant for disability insurance benefits or for supplemental
security income benefits based on disability who has an IQ score in the
range covered by Listing 12.05C and who cannot perform his or her past
relevant work because of a physical or other mental impairment has
perse established the additional and significant
work-related limitation of function requirement of Regulations 20 CFR Part
404, Subpart P, Appendix 1, section 12.05C.

Applicability of Ruling

This ruling applies to determinations or decisions at all administrative
levels (i.e., initial, reconsideration, administrative law judge (ALJ)
hearing and Appeals Council).

Description of Case

Branham

The plaintiff, Larry R. Branham, filed his claim for disability benefits
following a work-related injury allegedly sustained in October 1979, for
which he received Workers' Compensation benefits. Mr. Branham claimed
great back, hip, and neck pain associated with the injury; and he also
complained of chest pain, disorientation, and bronchitis. The plaintiff
had also been diagnosed as having a generalized anxiety disorder. He was
taking medication for all of his ailments.

Mr. Branham's claim for disability benefits was denied initially and on
reconsideration. After a hearing, the ALJ found that although the
plaintiff could not return to his past relevant work, he had the ability
to engage in light work and thus was not disabled. The ALJ therefore
denied his request for benefits and the Appeals Council upheld the
denial.

Upon review by the district court, the plaintiff submitted and the court
accepted additional evidence of his emotional problems and vocational
abilities, including the results of a test indicating an IQ of 63. The
court remanded the case for further proceedings.

On remand, a second ALJ heard the plaintiff's claim and granted Mr.
Branham benefits under section 12.05C of Appendix 1 of 20 CFR Part 404,
subpart P. The ALJ found that Mr. Branham's IQ fit within this section,
but referring to the finding of the first ALJ, held that the plaintiff's
physical problems held no significant work-related limitation of function
since Mr. Branham had the ability to do light work. The second ALJ did
find, however, that Mr. Branham's psychotic disorder, agoraphobia,
significantly limited his ability to work and was a mental impairment
within section 12.05C. The ALJ consequently decided that the plaintiff was
disabled as of January 15, 1983, the date the ALJ found the plaintiff's
agoraphobia began. The Appeals Council adopted the decision of the second
ALJ, awarding benefits on the basis of the plaintiff's IQ and mental
impairment.

On review, the district court modified the Secretary's decision, changing
the onset date of the plaintiff's disability from January 15, 1983 to
December 17, 1982, the date the claimant took his first IQ test. The court
found that Mr. Branham satisfied the physical impairment requirement of
section 12.05C on account of the 1979 back injury which led to the
termination of his employment and said that the claimant's inability to
perform his past relevant work as a laborer constituted a significant
work-related limitation of function. Mr. Branham appealed the onset date
of disability set by the district court, alleging that he met the IQ
requirement of section 12.05C prior to the time that he took his first IQ
test.

Holding

The Court of Appeals held that the plaintiff's inability to do his past
relevant work established the additional and significant work-related
limitation of function required by the regulation and determined the onset
of disability to be October 1979, the date of the injury to Mr. Branham's
back.

The court stated that the additional and significant work- related
limitation of function specified in section 12.05C need not be disabling
in and of itself, reasoning that if the claimant's physical impairment
were required to be independently disabling, section 12.05C would be
rendered meaningless. The court affirmed the finding of the lower court
that the plaintiff's back impairment was a significant work-related
limitation of function and remanded the case for an award of benefits. The
court cited for support an earlier decision, Rainey v. Heckler, 770
F.2d 408 (4th Cir. 1985).

Flowers

The plaintiff, Stroun A. Flowers, Jr., was born August 4, 1944. He
completed the seventh grade. From 1970 to 1971, he worked as a flag man
for a construction company and for the next seven years was a timberjack
driver. He had not worked since July 15, 1978. Mr. Flowers filed a claim
for supplemental security income payments. He alleged that he was disabled
due to seizures and a hip problem and that he met the requirements of
section 12.05C. The plaintiff had a verbal IQ of 72, a performance IQ of
66, and a full scale IQ of 68. Following the denial of his claim at the
initial and reconsideration levels, the plaintiff requested and received a
hearing before an ALJ. The ALJ agreed that the plaintiff met the first
part of Listing 12.05C, i.e., he had an IQ between 60 and
69;[1] that the plaintiff's
seizure disorder did not satisfy the "significant work-related limitation
of function" element. The ALJ also found that the plaintiff's low IQ and
seizure disorder did not prevent him from performing his former work and,
therefore, denied the plaintiff's request for supplemental security
income. The denial was upheld by the district court.

Holding

The Court of Appeals held that the ALJ's finding that the plaintiff's
seizure disorder did not prevent him from performing his former work was
not supported by substantial evidence. In its holding, the Court of
Appeals stated that it was following the Fourth Circuit rule announced in
Branham that if a claimant cannot return to his past relevant work,
he has established a work-related limitation of function that meets the
requirement of section 12.05C. Accordingly, the court vacated the decision
of the district court and remanded the case for an award of benefits.

Statement as to How Branham and Flowers Differ From Social Security
Policy

At issue in Branham and in Flowers is the meaning of the
term "additional and significant work-related limitation of function," as
contained in section 12.05C. What constitutes a significant work-related
limitation of function is not defined in the Secretary's regulations.
Agency policy is that the adjudicator in each case decides whether an
impairment constitutes a significant work-related limitation of function
based on all evidence, including the requirements of a claimant's past
work. The fact that a mentally retarded claimant has an IQ in the range
specified in section 12.05C of the Listing of Impairments and is also
unable to perform his or her past relevant work may or may not mean that
the claimant is disabled. It depends upon the facts of the particular
case. In the Fourth Circuit, the rule has evolved that an inability to do
one's past relevant work due to the additional impairment meets the
"additional and significant work-related limitation of function"
requirement of section 12.05C of the regulations.

Explanation of How SSA Will Apply Branham and Flowers
Within The Fourth Circuit

This ruling applies only where the claimant resides in Maryland, North
Carolina, South Carolina, Virginia or West Virginia at the time of the
determination or decision at any level of administrative review, i.e.,
initial, reconsideration, ALJ hearing or Appeals Council review.

A claimant who is mentally retarded and has a valid verbal, performance,
or full scale IQ in the range specified by section 12.05C of the Listing
of Impairments and also has a physical or other mental impairment which
prevents him or her from performing his or her past relevant work will be
considered to have established the requirements of section 12.05C of the
Listing of Impairments.

[1] At the time the ALJ issued
his decision, Listing 12.05C was applicable to claimants with IQ scores of
60 to 69 inclusive.

[1] At the time the ALJ issued
his decision, Listing 12.05C was applicable to claimants with IQ scores of
60 to 69 inclusive.

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